THE N W YORKER t , >a \ I: . .:; 4h \ X ow- \ \ I- -"'" " \ ....,J >to- ",,-- ---- \ --- -' ': ' t- ò r---- .....- --- , J -------- ---- -- ':,' that the trouble with it was that it was dOIng exactly what it was founded to do more than a century ago-healing the sick poor. Healing the poor has not been good business at all-a fact that has apparently been taken into consid- eration by many St. Francis doctors, who over the years have followed their wealthier patients to pleasanter areas, farther out in the Bronx or in West- chester County or in Connecticut. The number of private and semi-pri- vate patients in St Francis has steadi- ly decreased, and as the south Bronx has turned into a warren of tenements and rooming houses the numher of ward patients paid for by the city has grown. Earlier this year, the hospital reported that more than seventy per cent of its patients were in this category. The proper ratio, experts suggest, IS forty per cent city patients to sixty per cent paying patients. Because until re- cently the city paid barely three-fourths of the estimated cost to St. Francis of each indigent patient, the increasing proportion of patients unable to pay did 0:10 ì. &v, ::. ( ^\Ek:; ( '$ Xf*'A" t;j Y'," ". Nh , fi:.:Þ.(f ' r ,,^i t ., " ': , " \: f \ ,"'; 1 \ "" <<.t$' ... . r- , - t \ 4 ...... _i. , -- -f; -... Jllb... - ............. '1WtIJ 25 % r-... , /J -.; f. \\1 J f \ r. . , \ . t.,' , r; :' , ' 1 ' ^ ,', . J : ; \ ß i t 'J '" (f4 (v 'ì " " M- , '><,' ^ """'" 1'4 ., \., 1 "M A r t> ò''',ò \ J I ) ,5í , .:.. .- .K " "1 knew we shouJdn't have ig-nored that 'Merry Chrtstmas from the Boys' notice." not make for good hospital business. The Franciscan Sisters of the Poor didn't mind, but the people who know about business did. So, unfortunately, did the people who know about medi- cine. Although the hospital was con- sistently filled nearly to capacity-and, in some departments, beyond capaci- t}-it lacked a sufficient number of patients with the financial means to call on the services of medical specialists, and without the instruction and super- visIon of specialists the quality of train- ing that the hospital was able to pro- vide its residents and internes began to suffer. Something that added to the problem, the consultants informed the Sisters, was the outmoded, old-fash- ioned building itself. There were a lot of elderly workers around the place, too-workers who had been there as long as fifty years-and they obviously weren't pulling their weight anymore. Besides, when such workers werE' per- suaded to retire, the Sisters aHowed them to stay on as "boarders" and cared for them. And though it was . . nice that the Sisters and many of the nurses had taken the trouble to learn Spanish, that didn't help the hospital attract private patients. But the Sisters went right ahead, as they had been do- ing on 142nd Street since 1906. (For forty years before that, the order had maintained a hospital in downtown Manhattan to heal the sick poor.) In 1 960, the Hospital Review and Planning Counci1 of Southern New York, a quasi-public board composed of thirteen doctors and twenty-nine lay representatives of medical, civic, labor, religious, and charitable organIzations and charged with ad vising the State Health Commissioner on hospita] proj- ects, gave the Sisters a grave warning about economic conditions but, signifi- cantly, noted that the hospital would lend itself excellently to renovation. Th us encouraged, the Sisters began do- ing something about the professional- staff problem. Dr. Louis M. Rousselot, dIrector of surgery at St. Vincent's Hospita] and professor of clinical sur- gery at the N ew York University